Multimorbidity and disabling diseases in primary care
Keywords:
Multimorbidity; morbidity; persons with disabilities; functional capacity; health services for persons with disabilities; chronic disease/prevention & control; frailty; activities of daily living; quality of life.Abstract
Background: Multimorbidity constitutes a challenge for primary care, as it is related to loss of functional capacity, disability, frailty, polypharmacy, and the decrease in life quality.
Objective: To analyze the relationship between multimorbidity and disabling diseases, with emphasis on their determinants, clinical mechanisms, functional consequences, and possibilities for prevention and intervention.
Methodology: A narrative literature review was conducted of publications that appeared between 2016-2026, in Spanish and English. Bibliographic sources included PubMed/MEDLINE, Scopus, Web of Science, CINAHL, SciELO, LILACS, and the Cochrane Library. Studies analyzing the association between multimorbidity, disability, dependence, functional limitations, and primary care were considered.
Results: Multimorbidity is related to disability and frailty, especially in older adults. A comprehensive evaluation of multimorbidity in primary care is proposed, and a preventive model of disability in five phases is suggested. Early identification of frailty, treatment review, addressing social factors, and patient-centered care constitute relevant components of this response.
Conclusions: Multimorbidity associated with disability and dependence can be prevented in primary care through multidisciplinary coordination.
Downloads
References
1. Dong J, Yan M, Farmer A, Jiang L, Zhen J, Tonge Y, et al. The Impact of Social Isolation on Treatment Burden Among Community-Dwelling Adults With Disability and Multimorbidity: A Longitudinal Qualitative Study in Urban China. Health Expect [Internet]. 2026 [cited 2026 Jul 24];29(3). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC13163148/pdf/HEX-29-e70693.pdf
2. National Institute for Health and Care Excellence. Multimorbidity: clinical assessment and management. NICE guideline NG56 [Internet]. London: NICE; 2016. [cited 2026 Jul 24]. Disponible en: https://www.nice.org.uk/guidance/ng56
3. World Health Organization. Technical series on safer primary care: Multimorbidity [Internet]. Geneva: WHO; 2016. [cited 2026 Jul 24]. Disponible en: https://www.who.int/publications/i/item/9789241511650
4. Zhang J, Sun Y, Li A. The prevalence of disability in older adults with multimorbidity: a meta-analysis. Aging Clin Exp Res [Internet]. 2024 [cited 2026 Jul 24];36(1). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11387458/pdf/40520_2024_Article_2835.pdf
5. World Health Organization. Disability [Internet]. Geneva: WHO; 2023. [cited 2026 Jul 24]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/disability-and-health
6. World Health Organization. Primary care [Internet]. Geneva: WHO. [cited 2026 Jul 24]. Disponible en: https://www.who.int/initiatives/world-rehabilitation-alliance/primary-care
7. Polat G, Sofulu F, Düzgün G, Sütçü B, Ünsal Avdal E. Disability status and expectations of disability services among individuals with chronic diseases. PLoS One [Internet]. 2026 [cited 2026 May 30];21(7). Disponible en: https://doi.org/10.1371/journal.pone.0354824
8. Chamberlain AM, St Sauver JL, Boyd CM, Finney Rutten LJ, Fan C, et al. Multi-morbidity and patient-reported functional limitations: a population-based cohort study. J Multimorb Comorb [Internet]. 2022 [cited 2026 Jul 24];12. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9158431/pdf/10.1177_26335565221105448.pdf
9. Lynch DH, Petersen CL, Fanous MM, Spangler HB, Kahkoska AR, Jimenez D, et al. The relationship between multimorbidity, obesity and functional impairment in older adults. J Am Geriatr Soc [Internet]. 2022 [cited 2026 Jul 24];70(5):1442-9. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9106850/pdf/nihms-1775810.pdf
10. Aubert CE, Kabeto M, Kumar N, Wei MY. Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study. BMC Geriatr [Internet]. 2022 [cited 2026 Jul 30];22(1):910. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC9703785/pdf/12877_2022_Article_3548.pdf
11. Botoseneanu A, Elman MR, Allore HG, Dorr DA, Newsom JT, et al. Depressive multimorbidity and trajectories of functional status among older Americans: differences by racial/ethnic group. J Am Med Dir Assoc [Internet]. 2023 [cited 2026 Jul 24];24(2):250-7. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10280885/pdf/nihms-1905319.pdf
12. Lampe D, Grosser J, Gensorowsky D, Witte J, Muth C, van den Akker M, et al. The relationship of continuity of care, polypharmacy and medication appropriateness: a systematic review of observational studies. Drugs Aging [Internet]. 2023 [cited 2026 Jul 24];40(6):473-97. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10232587/pdf/40266_2023_Article_1022.pdf
13. Beridze G, Abbadi A, Ars J, Remelli F, Vetrano DL, Trevisan C, et al. Patterns of multimorbidity in primary care electronic health records: a systematic review. J Multimorb Comorb [Internet]. 2024 [cited 2026 Jul 30];14:1-18. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10829499/pdf/10.1177_26335565231223350.pdf
14. Coste J, Carcaillon-Bentata L, Robine JM, Trouvin AP, Humphreys J, Guillemin F. Trends in prevalence and disability burden of main rheumatic and musculoskeletal diseases in France 2008-2022. RMD Open [Internet]. 2026 [cited 2026 Jul 30];12(2). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC13182394/pdf/rmdopen-12-2.pdf
15. Zhu X, Wang Z, Yang X, Ning Z. About half of older adults have two or more chronic conditions at the same time: a systematic review and meta-analysis. Front Public Health [internet]. 2025 [cited 2026 Jul 24];13. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC12738304/pdf/fpubh-13-1680745.pdf
16. Vásquez F, Díaz E, López-Alegría F. Estrategias para mejorar el estado de salud de los pacientes con multimorbilidad en Atención Primaria de Salud: revisión sistemática. Rev Esp Salud Pública [Internet]. 2024 [citado 24 May 2026];98. Disponible en: https://ojs.sanidad.gob.es/index.php/resp/article/view/944/1275
17. Yao L, Li Q, Liu Y, Li Q, Wang T, Zhou Z, et al. How to assess multimorbidity: a systematic review. Front Public Health [Internet]. 2025 [cited 2026 Jul 30];13. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11983592/pdf/fpubh-13-1525593.pdf
18. Lu J, Li Y, Cao L, Zhao H. Effect of multimorbidity on old-age disability among adults over 50 years old: evidence from a meta-analysis. Public Health Nurs [Internet]. 2025 [cited 2026 Jul 30];42(1):524-34. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/phn.13444
19.Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, et al. Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways. J Intern Med [Internet]. 2019 [cited 2026 Jul 24];285(3):255-71. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC6446236/pdf/nihms-1016084.pdf
20. Medina Naranjo GR, Segovia Monga MC, Gómez Martínez N. La intervención de enfermería para el tratamiento de la depresión en adultos mayores. CCM [Internet]. 2026 [citado 30 May 2026];30. Disponible en: https://revcocmed.sld.cu/index.php/cocmed/article/view/5581/3014
21. Fisher K, Griffith LE, Gruneir A, Kanters D, Markle-Reid M, Ploeg J. Functional limitations in people with multimorbidity and the association with mental health conditions: Baseline data from the Canadian Longitudinal Study on Aging (CLSA). PLoS One [Internet]. 2021 [cited 2026 Jul 24];16(8). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8357170/pdf/pone.0255907.pdf
22. Thölking TW, Girard D, Engels Y, Schoon Y, van Wijngaarden EJ. Considerations of older adults with multimorbidity when facing healthcare choices: a qualitative systematic review. Patient Educ Couns [Internet]. 2025 [cited 2026 Jul 30];138. Disponible en: https://pubmed.ncbi.nlm.nih.gov/40493988/
23. Bunn JG, Steell L, Hillman SJ, Witham MD, Sayer AA, Cooper R, et al. Approaches to characterising multimorbidity in older people accessing hospital care: a scoping review. Eur Geriatr Med [Internet]. 2025 [cited 2026 Jul 30];16(4):1099-113. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC12378491/pdf/41999_2025_Article_1166.pdf
24. Smith SM, Wallace E, O'Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev [Internet]. 2016 [cited 2026 Jul 24];3(3). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC6703144/pdf/CD006560.pdf
25. Skou, S.T., Nyberg, M., Dideriksen, M. et al. Exercise therapy and self-management support for individuals with multimorbidity: a randomized and controlled trial. Nat Med [Internet]. 2025 [cited 2026 Jul 30];31:3176-3182. Disponible en: https://www.nature.com/articles/s41591-025-03779-4
26. Bricca A, Harris LK, Jäger M, Smith SM, Juhl CB, Skouet ST. Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. Ageing Res Rev [Internet]. 2020 [cited 2026 Jul 30];63:101166. Disponible en: https://doi.org/10.1016/j.arr.2020.101166
27. Kim T. Rehabilitation physical activity service systems for people with disabilities in Korea, the United States, Germany, and Japan: paradigm review and policy directions for Korea. BMC Health Serv Res [Internet]. 2026 [cited 2026 May 30];26(1):1063. Disponible en: https://doi.org/10.1186/s12913-026-14910-7
28. Correia RH, Dash D, Pasat Z, Strum RP, Aryal K, Kabir H, et al. Attributes of family physician encounters valued by older adults: a systematic review. BMC Prim Care [Internet]. 2025 [cited 2026 Jul 24];26(1). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11954301/pdf/12875_2025_Article_2794.pdf
29. Lim YW, l-Busaidi IS, Caya R, Bricca A, Mangin D, et al. Effectiveness of interventions for the management of multimorbidity in primary care and community settings: systematic review and meta-analysis. Fam Pract [Internet]. 2025 [cited 2026 Jul 30];42(6). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC12602864/pdf/cmaf085.pdf
30. Brown RT, Zamora K, Rizzo A, Spar MJ, Fung KZ, Santiago L, et al. Improving measurement of functional status among older adults in primary care: A pilot study. PLoS One [Internet]. 2024 [cited 2026 Jul 24];19(5). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11090365/
31. Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, et al. Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity. J Am Geriatr Soc [Internet]. 2019 [cited 2026 Jul 24];67(4):665-73. Disponible en: https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.15809
32. Shadmi E, Tonkikh O, Low M, Key C, Netzer D, Molcho T et al. The effect of nurse care management on multimorbid patients’ hospital utilization: a comparative-controlled trial and an exploratory cohort study. Nat Commun [Internet]. 2026 [cited 2026 Jul 30];17(1). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/pmid/42140977/
33. Fedecostante M, Balietti P, Beccacece A, Carrieri B, Orso M, Coin A, et al. Outcome measures for health interventions targeting multimorbid older adults: A systematic review. Ageing Res Rev [Internet]. 2026 [cited 2026 Jul 30];113. Disponible en: https://doi.org/10.1016/j.arr.2025.102940
34. Kim DH, Rockwood K. Frailty in Older Adults. N Engl J Med [Internet]. 2024 [cited 2026 Jul 24];391(6):538-48. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11634188/pdf/nihms-2020495.pdf
35. Sumner J, Ng CWT, Teo KEL, Peh ALT, Lim YW. Co-designing care for multimorbidity: a systematic review. BMC Med [Internet]. 2024 [cited 2026 Jul 24];22(1). Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10848537/pdf/12916_2024_Article_3263.pdf
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Jefferson Alexander Rosero Romero, Jorge Ricardo Rodríguez Espinosa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
La revista GME tiene Acceso Abierto (Open Access) a su contenido bajo las premisas de que el libre acceso mejora el sistema de comunicación científica, lo cual elimina cualquier barrera que impida el acceso a la información y de que el mismo autor es el máximo beneficiario de este movimiento, al proporcionarle ventajas tanto en su aspecto económico, científico, como en servicios de valor añadido.
Los autores conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra; podrán establecer acuerdos adicionales para la distribución no exclusiva de la versión de la obra publicada en la revista, con el reconocimiento de haber sido publicado primero en esta revista.
Todo el contenido de esta revista se encuentra en Acceso Abierto, distribuido según los términos de la licencia Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) que permite el uso, distribución y reproducción no comerciales y sin restricciones en cualquier medio, siempre que sea debidamente citada la fuente primaria de publicación.
Download here;